Clinical implementation of dynamic and step-and-shoot IMRT to treat prostate cancer with high risk of pelvic lymph node involvement

Adams, Elizabeth; Convery, D.; Cosgrove, V.P.; McNair, Helen; Staffurth, John; Vaarkamp, J.; Nutting, Christopher M.; Warrington, Alan P.; Webb, Steve; Balyckyi, Jan; Dearnaley, David P.

doi:10.1016/j.radonc.2003.09.004

Cited by 47 publications

(23 citation statements)

References 15 publications

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“…The medium value of 1000 proved to be the best for both algorithms. Actually there exists no clear consensus on precise constraints [20] neither unique in dose nor in volume fraction [2,6,8,11,12,20,22]. Our relatively narrow constraints, especially for the rectum, should pose a challenge for the optimising algorithms.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

IMRT of prostate cancer

Treutwein

Hipp²,

Kölbl³

et al. 2009

Strahlenther Onkol

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Background and Purpose: Intensity-modulated radiation therapy (IMRT) has shown its superiority to 3D conformal radiotherapy in the treatment of prostate cancer. Different optimisation algorithms are available: algorithms which first optimise the fluence followed by a sequencing (IM) and algorithms which involve the machine parameters directly in the optimisation process (DSS). The aim of this treatment planning study is to compare both of them regarding dose distribution and treatment time.Patients, Material and Methods: Ten consecutive patients with localized prostate cancer were enrolled for this planning study. The planning target volume (PTV) and the rectum volume, urinary bladder and femoral heads as organs at risk (OAR) were delineated. Average doses, the target dose homogeneity H, D 5 , D 95 , monitor units per fraction and the number of segments were evaluated. Results:While there is only a small difference in the mean doses at rectum and bladder, there is a significant advantage for the target dose homogeneity in the DSS-optimised plans compared to the IMoptimised ones. Differences in the monitor units (nearly 10% less for DSS) and the number of segments are also statistically significant and reduce the treatment time. Conclusion:Particularly with regard to the tumor control probability the better homogeneity of the DSS-optimised plans is more profitable. The shorter treatment time is an improvement regarding intrafractional organ motion. The DSS-optimiser results in a higher target dose homogeneity and, simultaneously, in a lower number of monitor units. Therefore it should be preferred for IMRT of prostate cancer.

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Section: Patients Materials and Methodsmentioning

confidence: 99%

IMRT of prostate cancer

Treutwein

Hipp²,

Kölbl³

et al. 2009

Strahlenther Onkol

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“…Many of the above studies used seven to nine fields in their fixed field IMRT plans which used a larger number of MUs compared with the five-field plans [91,92,95]. It is worth bearing in mind again, the number of MU in fixed field IMRT depends on the IMRT technique; usually more MU are required in the SW or dynamic IMRT technique [19,20]. The differences in MU between IMRT and VMAT found in studies using step and shoot IMRT are smaller than in the studies using the SW technique.…”

Section: Head and Neck Cancermentioning

confidence: 99%

“…The number of MU used in fixed field IMRT depends, to some degree, on the IMRT technique; usually more MU are required in the sliding window (SW) or dynamic IMRT technique [19,20]. In this technique, each radiation beam is modulated by continuously moving multileaf collimators (MLCs).…”

mentioning

confidence: 99%

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Teoh

Clark²,

Wood³

et al. 2011

BJR

571

440

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ABSTRACT. Volumetric modulated arc therapy (VMAT) is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT). The clinical worldwide use of VMAT is increasing significantly. Currently the majority of published data on VMAT are limited to planning and feasibility studies, although there is emerging clinical outcome data in several tumour sites. This article aims to discuss the current use of VMAT techniques in practice and review the available data from planning and clinical outcome studies in various tumour sites including prostate, pelvis (lower gastrointestinal, gynaecological), head and neck, thoracic, central nervous system, breast and other tumour sites.

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“…Compared with localized fields, however, pelvic irradiation carries the risk of increasing adverse effects rates, in particular for the intestine (5)(6)(7)(8). Although the typical shape of the lymph node target calls for use of IMRT (with the planning target volume very close to the intestine), relatively few institutions have yet reported on the application of IMRT for this subset of prostate cancer patients (9)(10)(11)(12)(13)(14). We have implemented IMRT for this patient group with the aim of reducing the normal tissue doses and toxicity, in particular those related to intestine irradiation.…”

Section: Introductionmentioning

confidence: 99%

Intensity-Modulated Radiotherapy of Pelvic Lymph Nodes in Locally Advanced Prostate Cancer: Planning Procedures and Early Experiences

Muren

Wasbø

Helle

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose: We present planning and early clinical outcomes of a study of intensity-modulated radiotherapy (IMRT) for locally advanced prostate cancer. Methods and Materials: A total of 43 patients initially treated with an IMRT plan delivering 50 Gy to the prostate, seminal vesicles, and pelvic lymph nodes, followed by a conformal radiotherapy (CRT) plan delivering 20 Gy to the prostate and seminal vesicles, were studied. Dose-volume histogram (DVH) data for the added plans were compared with dose-volume histogram data for the sum of two CRT plans for 15 cases. Gastrointestinal (GI) and genitourinary (GU) toxicity, based on the Radiation Therapy Oncology Group scoring system, was recorded weekly throughout treatment as well as 3 to 18 months after treatment and are presented. Results: Treatment with IMRT both reduced normal tissue doses and increased the minimum target doses. Intestine volumes receiving more than 40 and 50 Gy were significantly reduced (e.g., at 50 Gy, from 81 to 19 cm 3 ; p = 0.026), as were bladder volumes above 40, 50, and 60 Gy, rectum volumes above 30, 50, and 60 Gy, and hip joint muscle volumes above 20, 30, and 40 Gy. During treatment, Grade 2 GI toxicity was reported by 12 of 43 patients (28%), and Grade 2 to 4 GU toxicity was also observed among 12 patients (28%). With 6 to 18 months of follow-up, 2 patients (5%) experienced Grade 2 GI effects and 7 patients (16%) experienced Grade 2 GU effects. Conclusions: Use of IMRT for pelvic irradiation in prostate cancer reduces normal tissue doses, improves target coverage, and has a promising toxicity profile. Ó

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Clinical implementation of dynamic and step-and-shoot IMRT to treat prostate cancer with high risk of pelvic lymph node involvement

Cited by 47 publications

References 15 publications

IMRT of prostate cancer

IMRT of prostate cancer

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Intensity-Modulated Radiotherapy of Pelvic Lymph Nodes in Locally Advanced Prostate Cancer: Planning Procedures and Early Experiences

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